Many people seeking obstetric care in rural or underserved urban areas encounter barriers related to access.

Those in need of comprehensive, affordable, and high-quality obstetric care in rural and underserved urban areas encounter barriers related to workforce shortages, limited access to care, and reduced quality of care. These women may encounter a lack of resource availability within their local hospital to care for them or their babies (i.e., a lack of a NICU or blood resources) or long travel times to get to a better resourced hospital.

CRNAs are often the only specialists providing access to obstetric anesthesia services in rural hospitals, and studies show that they are more likely to practice in rural counties compared to anesthesiologists. They provide services in settings that often lack resource availability and staffing support. The aim of this study is to better understand how CRNAs are serving women residing in rural or underserved urban areas who need obstetric care.

NORC used mixed-method evaluation and data linkage techniques to understand the experience and impact of obstetric CRNAs in rural and underserved areas.

Through this project, NORC conducted a provider survey of CRNAs using Voxco, which allowed us to pre-populate hospital information and increase the reliability of hospital address data. NORC then linked CRNA responses to the survey, which asked about the anesthesia model used at the hospital as well as experiences providing obstetric care to different types of patients. Linking survey data to the AHRQ SDOH database allowed us to describe the different communities being served by CRNAs in these hospitals, their demographic and risk profiles, and access to health care services.

NORC also conducted a series of in-depth interviews to gather the stories of CRNAs working in rural and urban underserved areas and explored the possibilities of linking T-MSIS claims data to the survey data to better understand how health outcomes are influenced by anesthesia models of care.